P - 76711REQUEST FOR ELECTRICAL INSPECTION ���
2'� 14 �� 2 61 � Minnesota Board of Electricity � �,
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 �3.: �'
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Describe -using the back o the white copy if necessary - the work covered by this request:
JD � lo� i-77'7-'7$8S
GENERAL FEES Outdoor Li hting Standard $t
SERVICES / POWER SUPPLIES Traffic Signal Standard @$5
0 to 400 Ampere @$25 Supplemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Ampere @$75 Transformers over 10 KVA la� $ 20
I MUL
)MMUNICATION, REMOTE CONTROL,
CIRCUITS OF LESS THAN 50 VOLTS
iystem Device or Aqoaratus (�a $.50
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irrigation Boom @ $40
Manufactured Home Park Lots la� $25
ONE & TWO FAMILY DWEILINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Addftional ins ction Tri s $20
Investi ative Fee
Reins ection Fee $20
TOTAL FEE h
(minimum total fee is $20) p!� ��
THIS qR[A FOR INSPECTOR USE ONLY
I hereby certify thai I inspected ihe electrical installatian described herein on the dates stated:
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5 cial Ins ion $.31 er Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLE'fED WITHIN 12 MONTHS
��a �E REC'p ��Y : 21 2007
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Rough-in Inspedion Required? ❑ Yes �o I Inspection Other Than Rough-In: ❑ Ready Now�Will Call
SI� f O� You must call the inspector when ready! I Date Ready:
I certiy that I am the�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Address n` City
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Electrical UGlity Electrical Utility Address
Contrador / Co an �i@fgy Contrador License
9320 Evergreen.8lvd NW O�
Mailing Address n Cao��ny cy Q���g(Q�ing Installation)
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Master Electncian or Power Limited
License Number
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